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Dissertation/Thesis Abstract

Building Sustainable Chronic Care in a Free Clinic
by Larsen, William D., D.N.P., State University of New York at Binghamton, 2017, 148; 10282680
Abstract (Summary)

Management of chronic disease has become a key public health issue in the 21st century. Those who live with chronic disease have higher all-cause mortality and disability, and report lower levels of health satisfaction. The poor, persons of color, and those from marginalized social groups have worse health outcomes. These persons often face social or economic barriers that keep them from obtaining health insurance or utilizing medical services. Free clinics serve as a safety net for the under- or uninsured but frequently operate on a walk-in basis. This system of episodic care is not well adapted to serving the long-term health care needs of those who lack access to primary care. The Chronic Care Model is a system of care management that has been shown to be effective in managing chronic disease.

The purpose of this project was to examine implementation of the Chronic Care Model in a volunteer-run free clinic and assess its effects on patient perceptions of self-efficacy as well as their appraisal of care received for their chronic conditions. Patients with high self-efficacy engage in more self-care behaviors and along with high quality chronic care can result in improved health outcomes.

This project used a pretest-posttest reflexive control design for the quantitative measures with each individual serving as their own control. The qualitative measures were gathered using questionnaires and interviews with clinic stakeholders to assess the change and evaluate its impact on clinic process and structure.

The results favored the intervention with patients rating all aspects of their chronic care significantly higher at the posttest. Self-efficacy improved for a majority of participants, and significantly for managing emotional distress. Stakeholders found that elements of the change process were confusing and disruptive in the early stages but, once the change took hold, clinic function improved and patients were more satisfied with their care.

The Chronic Care Model appears to improve patient perceptions about the care they receive for their chronic conditions and modestly increase self-efficacy. This intervention may serve as a useful tool for volunteer-run free clinics that seek to improve the quality of chronic care provided to patients.

Indexing (document details)
Advisor: Johnston, Yvonne A.
Commitee: Anderson, Kathleen, Farley, H. Fred
School: State University of New York at Binghamton
Department: Nursing
School Location: United States -- New York
Source: DAI-B 78/12(E), Dissertation Abstracts International
Subjects: Medicine, Nursing
Keywords: Chronic care model, Chronic disease, Complementary and alternative medicine, Free clinic, Self efficacy, Uninsured or under-insured
Publication Number: 10282680
ISBN: 978-0-355-08405-4
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